16D2185380 CLIA NUMBER - SHENANDOAH PHYSICIAN'S CLINIC- TABOR

Laboratory Demographics

  • CLIA Code: 16D2185380
  • Facility Name: SHENANDOAH PHYSICIAN'S CLINIC- TABOR
  • Facility Address: 400 MAIN STREET
    TABOR, IA
    ZIP 51653
  • Facility Phone: 712 246-7245
  • Facility Type: Other - ARNP
  • Facility Type: Waiver
  • Lab Director: JESSICA HEITKAMP
  • NPI Number: 1508487547
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 16D2185380
LAB Type Other - ARNP
Facility Name SHENANDOAH PHYSICIAN'S CLINIC- TABOR
Street 400 MAIN STREET
City TABOR
State IA
ZIP 51653
Phone 712 246-7245
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/3/2024
Certificate Expiration Date 6/2/2026
Facility Type Other - ARNP
Lab Director JESSICA HEITKAMP

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This page was last updated on: 3/20/2025